title: Outcome and management of patients in whom sacral nerve stimulation for fecal incontinence failed.
abstract: BACKGROUND
  Sacral nerve stimulation fails in 30% to 50% of patients, the outcome that remains largely unreported.
  
  
  OBJECTIVE
  We report on the management and outcome of this cohort of patients.
  
  
  METHODS
  Ninety-one patients (88 females) with fecal incontinence, median age 63 years (range, 37-81), were candidates for sacral nerve stimulation. The follow-up protocol comprised incontinence and quality-of-life scores.
  
  
  METHODS
  Failure was defined on an intention-to-treat basis: after the test (<50% decrease of fecal incontinence episodes) or after permanent implantation (Wexner score >8). Subsequent management and functional results were recorded.
  
  
  RESULTS
  The mean Wexner score for the cohort decreased from 14.3 at baseline to 7.6 after a median follow-up of 31 months (range, 11-69). Sixty-one (67.0%) patients were implanted with a permanent pacemaker; 36 (39.6%) achieved success (group 1). Failure after permanent implantation occurred in 25 (27.5%) patients after a mean of 34.5 months (group 2). Failure after the test occurred in 30 (33.0%) patients, 12 of whom underwent further surgery (group 3) (including stoma, 2; anal reconstruction, 9; and rectopexy, 1), whereas the remainder chose conservative treatment (group 4). At the end of follow-up, group 1 had significantly lower Wexner scores compared with the rest (P < .0001) and superior Fecal Incontinence Quality of Life scores compared with groups 2 and 4 (P < .0001). Group 3 achieved a greater reduction in Wexner scores compared with groups 2 and 4 (P = .04), although the improvement in Fecal Incontinence Quality of Life scores did not reach statistical significance.
  
  
  CONCLUSIONS
  This was a nonrandomized study with retrospective stratification of patients.
  
  
  CONCLUSIONS
  On an intention-to-treat basis, success can be achieved in up to 40% of patients undergoing sacral nerve stimulation. In those in whom sacral nerve stimulation fails, further surgical treatment can yield favorable results in adequately motivated patients.
authors.affiliation: Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes - Hotel Dieu, Nantes, France.
authors.forename: Mark T C
authors.initials: MT
authors.lastname: Wong
authors.forename: Guillaume
authors.initials: G
authors.lastname: Meurette
authors.forename: François
authors.initials: F
authors.lastname: Rodat
authors.forename: Nicolas
authors.initials: N
authors.lastname: Regenet
authors.forename: Vincent
authors.initials: V
authors.lastname: Wyart
authors.forename: Paul-Antoine
authors.initials: PA
authors.lastname: Lehur
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D019160:Endosonography; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000502:physiology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D017211:Treatment Failure; D016896:Treatment Outcome